MEDICARE: NEW IMAGE WELLNESS CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1205568631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW IMAGE WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	5440 W SAHARA AVE STE 301
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-0361
Country	:	US
Telephone Number	:	702-996-7114
Fax Number	:

Provider Business Practice Location Address
First Line	:	5440 W SAHARA AVE STE 301
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-0361
Country	:	US
Telephone Number	:	702-996-7114
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. KATHY MARIE HOWARD
Credential	:
Telephone Number	:	702-996-7114

Provider Enumeration Date	:	06/24/2022
Last Update Date	:	10/14/2022

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